Elsevier

Public Health

Volume 127, Issue 8, August 2013, Pages 716-726
Public Health

Original Research
Delivering men's health interventions in English Premier League football clubs: key design characteristics

https://doi.org/10.1016/j.puhe.2013.04.011Get rights and content

Abstract

Objectives

To investigate the key design characteristics of Premier League Health (PLH), a national programme of men's health improvement delivered in/by 16 English Premier League (EPL) football clubs.

Study design

Health Trainers (HTs) were hired by EPL clubs to deliver PLH. HTs were the focus of investigations aimed at identifying the active design characteristics of male-specific health promotion interventions.

Methods

Semi-structured interviews led by researchers were performed with 13/16 HTs and identified the key design characteristics influential in (I) reaching and (II) helping participants adopt health improvement interventions delivered in professional football club settings.

Results

HTs believed that combining the appeal of football alongside EPL clubs, offered a unique opportunity to reach adult males, including hard-to-engage-men (HTEM). Awareness raising events held on match days aimed to connect with men, but outreach activities were especially important for engaging participants. Following initial reach, familiar settings, such as the club stadia and community venues were also important for ensuring regular involvement in health improvement sessions. Interventions shaped around men's health needs and delivered at times when participants could more easily attend, were factors which helped to engage men. Supportive social environments and a range of exercise modes and delivery options were also seen by HTs as being similarly important. Both the informality and familiarity of EPL clubs were viewed by HTs as having substantial advantages over conventional NHS settings for reaching and engaging men. Importantly, HTs contributed substantial skills to the delivery of PLH.

Conclusion

Although, top flight professional football clubs can recruit men, including those regarded as hard-to-engage into health improvement programmes, considerable attention to delivery refinement is needed to support male participants adopting interventions aimed at promoting healthy lifestyles.

Introduction

Recruiting men, including so-called hard-to-engage-men (HTEM)1 into both health improvement activities and health advice services delivered in primary-care (PC),2 continues to pose a challenge for the promoters of men's health.3 Research shows that there are men who present with unhealthy lifestyles, but neither engage in PC,2 nor make use of health advice and information services4 and as such, can be classed as hard-to-engage.1 It is these men who are unlikely to be exposed to conventional health promotion messages and activities delivered through these channels. This is a particular concern for young adult men, as these are at a heightened risk of incubating the diseases of middle to old age5 including, cardiovascular disease, fat-related cancers and poor mental health.5, 6

Unhealthy lifestyles further combine to amplify already concerning health trajectories,7 where a common set of problematic health practices are the bedrock of these non-communicable diseases. It is these conditions that also pose great financial expense to world healthcare services annually.8 With those thoughts in mind, the cost of implementing a set of ‘best buy’ health interventions remains relatively low,9 but the health outcomes remain potentially high.9, 10 Yet, it remains clear that the key ingredients of such interventions specifically directed at improving the health behaviours of men, are less well understood.3, 11

Studies have shown that a number of important issues exacerbate the problem of men's poor behavioural health and their ability to access health care. Firstly, men can harbour fatalistic attitudes about their health, and view their wellness as predetermined.12 Secondly, chronic conditions, including obesity, can be associated with self-blame and stigma resulting in an unwillingness on the behalf of men to seek help.13 Thirdly, employment, lifestyle commitments and surgery opening times3 can impede men's attendance at PC. Finally, men can view the doctor's surgery as a feminized environment3, 14 and not suitable for meeting their health needs.3, 4 These, along with a host of other barriers, conspire to impact on men's attendance rates in PC. However, research also shows, when compared to women, there is no evidence that men delay in seeing their General Practitioner (GP) when they recognize their symptoms.15

With these issues in mind, the European Commission,16, 17 recommend promoting gender-specific activities which raise men's awareness of health issues that represent a risk to their well-being. When delivering interventions that help facilitate positive behavioural change, Fineberg,18 offers six criteria for the provision of effective health improvement systems. Successful interventions should aspire to develop Healthy People, provide Superior Care and do so Equitably. In sustaining successful health improvement, interventions should also be Affordable, Acceptable and Adaptable to participants.

With those criteria in mind, research suggests using specific community settings to reach men with health promoting interventions, including the workplace,19 religious venues,20 job centres21 and community housing projects.22 Surprisingly, few studies have looked at the effect of leisure and sporting contexts for this purpose,23 meaning that there is a paucity of evidence regarding how to optimize programme development and delivery aimed at men in this setting.

In the UK, professional association football clubs represent a culturally acceptable channel to connect with men displaying a more general interest in football, along with fans of individual clubs. In the case of the latter, the reach of the football club ‘badge’ offers a potentially influential route to connect male supporters24 and otherwise HTEM25, 26 with health improvement programmes. Indeed, research has shown the considerable potential of football clubs for engaging men with health promotion activities.24, 27, 28 Such is the power of this setting, some HTEM, report that they would not have engaged the same health improvement intervention, had it been delivered in a conventional health service environment.26 These findings provide considerable optimism for the potential of professional football clubs as key agents for implementing men's health promotion activities.

However, research is needed to identify the impact of different elements of male-specific health interventions delivered in professional football contexts. This should not only include behavioural outcomes, but also insights into the process(es) by which such outcomes are achieved. Recently, Conn and colleagues have performed investigations into the active design characteristics of PA interventions. However to one's knowledge, none of the studies included in this review were centred on male-specific, activity-led health improvement programmes delivered in/by EPL professional football clubs.29

Recognizing the need for investigations on how football based health interventions are put into practice with men, the authors set out to investigate from a ‘delivers’ perspective, the key design characteristics of a programme of men's health promotion implemented in/by EPL football clubs. In doing so, this study was guided by the REAIM framework.30 REAIM not only provides a comprehensive structure for assessing the impact of interventions across the behavioural change continuum (Reach, Adoption and Maintenance), but also the process (Implementation) by which interventions are (Effective) when impacting on the behaviour of participants. As such, findings from this study have potential to help inform decisions on the design and selection of interventions aimed at male-specific health improvement in line with those principles set out by Fineberg for successful health care.18

Section snippets

Study context

Premier League Health (PLH) is the first nationally-based programme of men's health promotion delivered through 16 English Premier League football clubs.31, 32 Interventions were led by Health Trainers (HTs), allied health professionals and staff employed by the clubs. HTs implemented activities to meet the specific needs of their potential recruits. With no standardized delivery pattern, activity-led interventions were planned and implemented over three years, typically targeting men aged

Results

Using the perspectives of the 13 HTs, this study suggests the key design characteristics for how men are both reached and adopt gender-specific health promotion activities delivered in/by EPL clubs.

Discussion

It has been estimated that primary prevention, including the modification of health practices can potentially save costs10, 35 and improve health.10, 16, 17, 35 In the UK, there is an emerging case for health improvement delivered to men through sporting settings,16, 17 including professional football club clubs.3 Such settings provide venues that are both accessible to men, including HETM,25, 26, 32 and can offer an opportunity to address injurious health practices.24, 26, 32 Therefore,

Conclusion

Health improvement programmes delivered in top flight professional football clubs can reach and engage men, including those not using health services32 and positively influence men's health.31, 32, 45 However, considerable attention to delivery refinement is needed to support the adoption by men, including those resistant to health improvement campaigns delivered in PC. Interventions used inventive promotional efforts and recruitment processes including, the use of gender-specific promotional

Acknowledgements

The authors gratefully acknowledge the contributions of all those individuals who took part in the research and agencies who partnered Premier League Health, including the Football Pools, the FA Premier League and the staff in the EPL clubs.

Ethical approval

Ethical approval was sought from the Carnegie Faculty Research Ethics Committee at Leeds Metropolitan University.

Funding

The Premier League Health Programme was supported by the FA Premier League (the commissioners) who received funding provided by the Football Pools

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